Questions to Ask Explant Surgeons
The following is a comprehensive list of questions to ask explant surgeons during your consultations. Asking these questions will help you find a surgeon dedicated to proper explant which is an En Bloc / Total Capsulectomy explant. There are also important questions to ask about pathology, recovery, after care and about having your implants returned to you.
- Are you a board certified Plastic Surgeon? Do you have hospital privileges? Do you have medical malpractice insurance? If a surgeon has their own surgical suite but does not have hospital privileges, find out why. Having hospital privileges is key to ask as it means they are trained and certified in plastic surgery and in good standing with the medical community. Also hospital privileges are important if you were to have a serious complication during surgery that would require entry to a hospital to save your life and a surgeon without hospital privileges cannot help you in those circumstances. Surgeons lose their hospital privileges for significant reasons and you should be aware of those reasons but may not have access to the information unless you ask. Surgeons lose their malpractice insurance too for serious reasons such as multiple malpractice suits and you may not have access to that information unless you ask. Is the surgical facility accredited? Learn more about surgical facility accreditation here: http://www.americanboardcosmeticsurgery.org/patient-resources/facility-accreditation/
- Ideally breast implants should be removed En Bloc Capsulectomy if possible and always with a Total Capsulectomy which means remove all capsule tissue including capsule tissue attached to the chest wall. En Bloc is important for ruptured, leaking, bleeding silicone and textured implants to minimize silicone contamination to you. Total Capsulectomy may suffice for smooth saline implants if you are not symptomatic but if you are symptomatic you may want En Bloc Capsulectomy for smooth saline too. For all explants of breast implants all capsule tissue should be removed from your chest for your highest and best recovery from breast implant illness symptoms because capsules are full of silicone gel, particulate and biofilms of infectious organism. Do you have En Bloc Capsulectomy explant skills and experience? How long have you been explanting and how many En Bloc explants have you done? Do you have Total Capsulectomy skills and how many Total Capsulectomies have you done? They should have at least 50 or more under their belt. Can you provide photos of previous En Bloc / Total Capsulectomy explants? Will you provide photos of my En Bloc / Total Capsulectomy explanted capsules and implants evidencing entire removal of capsule tissue? Photos are the only way they can prove they removed your implants En Bloc / Total Capsulectomy. Are you committed to removing all capsule tissue from my chest including capsule tissue on the chest wall and will the surgery contract state Total Capsulectomy to ensure this commitment? Choose a surgeon that is committed to removing all capsule tissue from your chest as we know that removing capsules correlates with our healing from breast implant illness. How long will the surgery take? Thorough En Bloc / Total Capsulectomy explants usually require a general anesthetic and take approximately two hours or longer of surgery time.
- Do you do muscle repairs and or inframammary fold reconstruction if necessary? Here is a good video explaining why muscle repairs may be necessary. Inframammary fold or crease reconstruction is ensuring the anatomical breast crease lands in the same area it should after larger implants are removed.
- In regard to BIA-ALCL, if you have swelling, seroma, breast mass or capsular contracture and textured implants, please push for BIA-ALCL testing upon removal of your implants. If a seroma is discovered during explant will you aspirate and send the fluid and capsules for CD30 Immunohistochemistry to rule out BIA~ALCL? Please do not assume that surgeons automatically know to do this, many do not know and discard the fluid. We have to educate explanting surgeons to do the CD30 test and to follow proper testing procedures for BIA-ALCL which is likely more widespread than the medical community acknowledges.
- Can I see an advance copy of all presurgery paperwork that must be signed. Do I have to sign a confidentiality agreement or a non-disclosure agreement with this surgeon? This is a relatively new angle that surgeons have come up with after the consult and deposit are paid and right before the surgery they attempted to force patients to sign a nondisclosure/confidentiality agreement so the patient cannot report their surgery experience online. We suggest walking away from surgeons trying to force confidentiality agreements.
- What kind of anesthetic is used during surgery and what can I expect with it? Is anything else added to the anesthetic and if so how will it affect me? If I am MTHFR positive will my condition affect anesthesia procedures? MTHFR people are recommended to avoid Nitrous Oxide as it greatly depletes B12 levels which exacerbates our symptoms.
- Will I receive antibiotics during the surgery, what kind will be used and how will they affect me? Will I receive any other medication such as an anti-nausea medication? Some surgeons use steroids during surgery. Lyme ladies should be cautious about steroids as they can worsen Lyme.
- Will you use cautery during surgery which reduces bleeding? How will you control bleeding or blood clotting if necessary to do so? Will the stitches be dissolvable or do they have to be removed? Will any foreign materials be used such as staples, permanent stitches, mesh etc? We highly suggest against all foreign materials because these cause symptoms too. Some lift procedures use mesh and we highly advise against mesh or other similar products as it causes problems too.
- What kind of pain medication will be prescribed and how will it affect me?
- Are pieces of capsule tissue sent to pathology to check for bacterial and fungal infections and also the rest of the capsule to check for silicone, various immune reactivity cells, cancer or BIA-ALCL if applicable. Do you send the implants to pathology to document their state and if they are leaking or ruptured. Will you test saline fluid for colonization by microorganisms such as mold if applicable by sending to labs that test for fungus such as Mycometrics or Real-Time Lab? How much will any of this testing cost?
- What do you do to clean out the chest pocket if it is contaminated with silicone and or microorganisms?
- If you are dealing with a grossly ruptured silicone implant where silicone travelled to the lymph nodes, does he check lymph nodes for silicone through ultrasound and localization techniques and remove lymph nodes that cannot be saved?
- Do you take pictures or video of the explant procedure? We recommend getting the following video or pictures signed off by him; one of you with your implants still in before surgery, one of you after explant without your implants while on the surgery table, picture of the implants with capsule tissue still on to prove En Bloc removal and pictures of the implants and capsule tissue separately to document capsulectomy.
- Can I have a copy of my complete file including operative reports, pictures and tests at our first follow up meeting?
- Will you pack up and return my uncleaned implants and capsule tissue to me if I request? Or send them elsewhere if you request? If you are interested in legal, check with your attorney about how your implants should be handled to preserve your case.
- Will I have drains and what should I expect with drains and how will I care for drains while I have them? Who will remove the drains?
- What are the signs of an infection after explant? What are the signs of a seroma or hematoma after explant? What are the procedures if symptoms of these occur?
- If you are explanting due to rupture, capsular contracture, pain or infection and your insurance covers you for explant will the surgeon work through your insurance or provide you the letters required for you to apply to insurance for a reimbursement yourself?
- Is there a deposit required and what happens with the deposit if I have to cancel or postpone at anytime?
- What are pre-surgery directions for avoiding supplements and medications and what are after surgery directions for compression, wound care, sleeping, massage and who will I call if have problems or questions after surgery?
- Will he prescribe antibiotics for bacterial infections in the chest or antifungals if the implants are colonized with fungus or if you experience an overgrowth of fungus in the gut and body due to antibiotics from surgery.
- How long will it take for my breasts to heal and feel normal? When will the follow up appointments be and how many? What can I expect in terms of size of explant incision scars.
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This Post Has 47 Comments
Most surgeons have a god complex, so asking alot of questions like this will likely reveal if he/she takes offense so we wave bye bye.
Wish I knew to ask affiliations before, and why I could not post anything on Social Media on his work before. The $10K implant got infected at surgery area and got deformed. He refused to fix it. I also wonder what happened to saline implants he replaced, and their condition since both became capsulized.
Is it really necessary for me to have a total capsullectomy if I’ve never had any problems with my implants? I’ve had 3 sets , the first set were saline , under the muscle through my belly button, the second set were gummy bear implants under the muscle. And the 3rd set are also gummy bear under the muscle. The current gummy bear implants have been In Since 2015 also this last set is textured 350cc Mentor implants
Thank you !
Yes, there is no question, when a woman explants her implants all the capsule tissue should be removed for her highest and best healing. The capsule is your body’s immune response to the implants, it contains silicone gel, silicone particulate and chemicals and heavy metals of silicone and can contain infections. Leaving it in your body exposes you to the contents of the capsule. Also the capsule adheres to your muscles and can cause a pulling and pain. The left over capsule can cause a continuation of your body immune responses too.
But if I have no pain just want implants out do I have to insist that all the capsule adhere to the ribs be removed? I would tell you all my stats if you are interested.
Yes, when you explant all capsule tissue should be removed, it can contain silicone particulate and silicone chemicals and heavy metals. Capsule can also contain infections and it is the body’s immune response to the implant and so stimulates autoimmune. Why would you leave that in your chest? Left over capsule does not dissolve on it’s own and it can cause pain and inflammation and calcification.
Would have never thought to ask half of these questions! So Helpful! Thank you for the great resources!
Comments on Dr.Raman C. Mahabir in Phoenix/Tucson Arizona. Have heard good things….. silicone implants put in 44 yrs ago. I’m 70 yrs old.
I thought i was the only one with 40 YO implants! Just starting on my journey to have them removed. Please keep your story posted, im very anxious about having such old implants removed!
I’m 77 yrs old and have 32 year old implants. (42 yrs if you include the original implants)
I have an explant date of Oct 24th but am also anxious to hear other stories of older implants!
Becky who is doing your surgery?
Sorry, I just saw your question.
Dr Sayed, Newport Beach did my explant last week, Nov.14th, 2022
Oh boy! So much information that I had no idea I needed to know!! Thank you! I go for my consultation to explant next week and these questions are so informative. This doctor put my implants in 7 years ago, 7 months after my double mastectomy for breast cancer. I am also actively treating Lyme disease, heavy metals toxicity, and mold illness. Wish me luck!
Lynn, he is my ps and I need them explanted. What can you tell me about your experience? I really like him as he did my implants. I need them removed due to capsuler contracture and I’m always intimidated asking questions.
Hi did you ever hear anything about Dr Raman Mahabir?
I’ve had my implants since 2008. When the Dr did the surgery he said it was best to put them under the muscle. Now that I am starting my research to have them explanted, I read one of the Illinois Drs sites saying that doing a full en bloc capsulectomy when under the chest muscle is not always the safest because the scar tissue attaches to the muscle and the ribs. Has anyone had a full en bloc when the implants were behind the chest muscle?
Yes, En Bloc Capsulectomy or Total Capsulectomy are possible with under the muscle implants, if the surgeon has problems completing En Bloc then Total Capsulectomy will suffice. What’s most important is that all capsule tissue is removed from your chest. Left over capsule tissue continues to aggravate the immune system and causes inflammatory conditions and it is also contaminated with silicone chemicals, heavy metals and silicone particulate. All capsule tissue needs to be removed, En Bloc should be attempted but if that’s not possible then Total Capsulectomy.
Hi Nicole, what is the difference between an Enbloc and total capsulectomy? I thought it was the same thing?
We explain the difference between En Bloc Capsulectomy and Total Capsulectomy here: https://www.healingbreastimplantillness.com/explant/.
Hi, I al looking for surgeons in Saskatchewan, Canada. Would someone be able to show me the list? Thanks
We have not yet found a good explant surgeon in SK.
Do you have a list of doctors for the Ontario, Canada area. I am close to kitchener, Hamilton, Toronto area. Thank you in advance.
Yes, on this website there is a list of surgeons known to remove breast implants properly in Ontario Canada here: https://www.healingbreastimplantillness.com/explant-surgeons/.
This is extremely helpful and has more understandable information in one post than I have found in weeks of searching for my specific situation! (sudden onset of 4 autoimmune diseases) Thank you for this! 🙏💛
Thank you! I found it! It was an oversight the other night, but I was exhausted, so that is why I asked on the group page thinking there was a file there.
When the surgeon does the En Bloc procedure does he have to take out some of the natural breast tissue that surrounds the implant? I was a C before I children. After breast feeding three kids I shrunk to a B. I am just wondering if I will have any breast tissue left.
No, no breast tissue is removed when a surgeon explants you.
Any chance this post could be made more gender neutral? Just think it would be nice to acknowledge that women can be surgeons, too 🙂
Any recommendations on explant surgeons in Milwaukee WI
Greater Milwaukee Plastic Surgeons
Is there a way to get our insurance companies to pay for Explant surgery? Could you please help out with information on that, or a website to go to? I went to one of the surgeons on your list, but he said it was next to impossible.
Thank you so much for doing this,
Hi Lynda, also on our website under the Resources section is a page on Insurance and Explants here: https://www.healingbreastimplantillness.com/insurance-explants/, which is our best advice regarding insurance. Also inside the facebook group is a post about which surgeons may go through insurance for each state if we found one for that state.
Thank you so much, Nicole! I did try to get on Facebook, but I am on it with my husband (though neither one of us use it very often) and I guess that is against the rules. The name on FB is Jeffery Lynda Gibson if I’m allowed to join.
Once again, thank you so much for your help!
Hi, what is the Facebook group so that I can join? Many thanks!
Hi Stephanie, our facebook group is here: https://www.facebook.com/groups/Healingbreastimplantillness.
On July 7th I went thru replacing my old silicon implants from 2007 with Ideal saline implants. Since this is not my first breast implant replacement, I thought it would be easy. Wrong! Next day I was back at the surgeon’s office as my left breast was very swollen and hot. Since I had drains he told me no problem he just had to work harder on that breast due to capsular contracture. So a month later I know have a very hard left breast and I am done. Having read so much helpful information I am now worried about going back to the same doctor to get both removed for good. He does a lot of reconstructive surgery but after having gone through this surgery, I am not sure if I can trust him. Worse I am not sure who to go to as I live in South Carolina and this surgeon was in August, GA. Thoughts?
How do I find out who is an expert explant surgeon in my area?
Hi Jill, the Explant Surgeon’s list is also on the website, its long so scroll down to your country and then state.
can i apply for disability while i’m off work to heal or get the procedure done? Will insurance cover the removal?
Searching Doctors in California based on person experienced. Santa Monica Area and near, Also Calabassas Ca.
Have you seen the list of explant surgeons for CA on our website here, scroll down the list until you get to your state: https://www.healingbreastimplantillness.com/explant-surgeons/.
Hello Anllela: Read you are in Chicago and at this point should of had explant surgery. I am interviewing surgeons in Chicago, from list, yet was wondering who you elected to go with; I am seeking an actual recommendation of personal experience? Thanks, Pamela
I highly recommend Dr Pryor!
Can anyone recommend a surgeon in Norway?
Yes there is a surgeon in Norway, scroll down this list until you get to Norway: https://www.healingbreastimplantillness.com/explant-surgeons/.
I see no one in Norway on this list? I am also from Norway, but are planning on travel to Sweden.
I am 62 and have had implants for 40 years. I don’t have a lot of the symptoms. I had 2 serious bouts with severe depression and need to take 3 anti depressants now. I had unexplained bleeding and had to have a total hysterectomy last month. I also have a lot of GI upset on and off. I have increasing pain in several joints which i assumed was just part of aging and arthritis. After reading all the info on the website, I too am thinking about having my implants removed. I am still undecided and don’t have an extra $11,000 to pay for it. I do have Blue Shield PPO insurance. My last Mammogram indicated possible rupture on one implant. I occasionally get sharp pains at the site. I also have intermittent heart palpitations. It’s so confusing to know if these conditions are related to the implants since I went so many years without issues. Let me know what you decide to do.
That’s a lot of symptoms listed there for “not having a lot of symptoms”! I find that most women don’t attribute their symptoms to BII when they are all symptoms of BII and due to our implants! I didn’t think I had a lot either, nothing too debilitating but after I wrote out my list of symptoms, I had 20+ I didn’t even realize I had! I am getting my consult tomorrow and hopefully explanting asap!